Provider Demographics
NPI: | 1962475129 |
---|---|
Name: | ABRAMS, LORI A (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | LORI |
Middle Name: | A |
Last Name: | ABRAMS |
Suffix: | |
Gender: | F |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3131 S TAMIAMI TRL |
Mailing Address - Street 2: | SUITE 202 |
Mailing Address - City: | SARASOTA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34239-5101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 941-953-5340 |
Mailing Address - Fax: | 941-955-8568 |
Practice Address - Street 1: | 3131 S TAMIAMI TRL |
Practice Address - Street 2: | SUITE 202 |
Practice Address - City: | SARASOTA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34239-5101 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-953-5340 |
Practice Address - Fax: | 941-955-8568 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-02-08 |
Last Update Date: | 2007-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OS 7418 | 207VG0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 239574 | Other | AVMED |
FL | 57586 | Other | BLUE SHIELD OF FLORIDA |
FL | 7005077001 | Other | CIGNA |
FL | 2002369 | Other | AETNA |
FL | 7005077001 | Other | CIGNA |
FL | G64867 | Medicare UPIN |